Affiliation Agreement Residency Rotation Agreement Clinical Service Agreement Volunteer Activity by johnrr1

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									Affiliation Agreement/Residency Rotation Agreement/ Clinical Service Agreement/Volunteer Activity Processes (modified 11/3/05) A. For UK residents/fellows rotating out 1. Program directors (PD) negotiates agreement with "outside" health care provider (OHCP). Assures training objectives are established, that training will meet ACGME RRC requirements, and that there is an identified supervisor for the resident/fellow(s). Note: Funding source for resident/fellow line must be taken into consideration when negotiating agreements. If the outside training is not required to meet ACGME program requirements, then the department or the OHCP (outside health care provider) must provide funding to support salary and fringe benefits for the resident/fellow's time there. If the training is required to meet ACGME program requirements and it cannot be provided in-house, institutional support for the rotation may be provided if approval is obtained in advance from the associate dean for Graduate Medical Education, AHEC, and Community Outreach or designee, and a written request for support is submitted in a timely manner. Departments not obtaining approval in advance will be billed for the resident/fellow's time. 2. Agreement form obtained from GME office. PD completes 2 originals of agreement form. (Address on forms must be complete - to include street address, city, state, zip code and contact name and phone number.) Have department chairperson and program director sign both originals. Assure competencies/educational objectives are attached, and that agreement addresses required elements as delineated in ACGME program requirements. 3. Forms then sent to GME office, along with name of facility CEO if known. 4. GME office staff logs in forms, reviews and sends to OHCP for signature of supervisor and facility CEO. 5. Upon return, forms given to associate dean for Graduate Medical Education, AHEC, and Community Outreach for signature. 6. Forms logged out and sent to dean's office for signature. 7. After all signatures obtained, dean's office keeps one original on file, returns other to GME office. 8. GME office sends original to OHCP, and copies to PD and department chairperson. Copy filed in GME office. 9. Annually, agreements sent to PD & OHCP for review and renewal for following year. Note: Residents/Fellows cannot rotate out without a fully signed agreement. B. For residents/fellows from other institutions rotating to UK 1. Program director (PD) negotiates agreement with "outside" institution (OI). Assure competencies and educational objectives are established, that training will meet ACGME RRC requirements, and that there is an identified supervisor for the resident/fellow(s). Note: For residents/fellows coming to practice at the PGY2 or above level, must be licensed in state of Kentucky. 2. Agreement form obtained from GME office. PD completes 2 originals of agreement form. (Address on forms must be complete - to include street address, city, state, zip code and contact name and phone number.) Have department chairperson and program director sign both originals. If OI has own form, can use that. 3. Forms then sent to GME office, along with name of facility CEO if known.

4. If UK forms, GME office staff logs in forms, reviews and sends to OI for signature of supervisor and facility CEO. If OI forms, GME office staff logs in forms, reviews and sends to dean's office for legal counsel review. 5. UK residency/fellowship program/department staff is responsible for obtaining complete application packet for rotator and for providing to GME office staff so that credentials can be verified and so that we can assure all requirements are met. Once appointed as a rotator the department is also responsible for obtaining and providing to the rotator an I.D. badge, parking permit, dictation number, pager, etc., and for assuring rotator completes required training (HIPAA, Sexual Harassment, Corporate Compliance, OSHA training and SCM training). Documentation of the required training will need to come to the GME office so we can assure it goes to the right offices and so that we can keep a copy in her file here. The department is also responsible for making sure rotator clears through medical records and the cafeteria before leaving the University. You are welcome to obtain the GME office's clearance sheet. Contact Stacey Wilks at 323-5873 to get a copy. 6. Upon return, agreement forms given to associate dean for Graduate Medical Education, AHEC, and Community Outreach for signature. Application packet reviewed and credentialing process initiated. 7. Agreement forms logged out and sent to dean's office for signature. 8. After all signatures obtained, dean's office keeps one original on file, returns other to GME office. 9. GME office sends original to OI, and copies to PD and department chairperson. Copy filed in GME office. Note: Outside residents/fellows cannot work here until credentialing process and agreement are complete (fully signed). C. Clinical Service Agreements or Contract - if involve residents/fellows, should so state in agreement/contract, and dean's office will forward to GME office for review & signature of associate dean for Graduate Medical Education. GME office will get copy when fully signed. Assure compentencies and educational objectives are attached and that agreement/contract addresses required elements as delineated in ACGME program requirements. D. Volunteer activities - If a resident/fellow is to be assigned to an activity that is voluntary and without pay (e.g., Indian Summer Camp, Nathanial Mission, etc.): 1. A memo needs to done in advance indicating the name of the resident/fellow, the activity, and the duration of activity. 2. The memo should be sent to the GME office, where it will be reviewed, logged in, and forwarded to the associate dean for Graduate Medical Education, and then the dean's office. 3. The dean will review it and, if in agreement, will do some type of acknowledgment letter sanctioning the activity on behalf of the university. A copy of the letter will be sent to the GME office. GME office staff will send a copy to the PD and department chairperson and will keep one on file.


								
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